Parasternal Intercostal Block With Ropivacaine for Pain Management After Cardiac Surgery: A Double-Blind, Randomized, Controlled Trial

Barr, Althea; Tutungi, Elli; Almeida, Aubrey

doi:10.1053/j.jvca.2006.09.003

Cited by 78 publications

(81 citation statements)

References 20 publications

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“…12 these findings are consistent with the study by Althea M [20]. Althea M. Barr [20] showed that ropivacaine parasternal block is an effective treatment for sternal wound pain. It is a safe, simple, and effective adjunct for optimizing of pain control and reducing opioid analgesics after adult cardiac surgery.…”

Section: Discussionsupporting

confidence: 91%

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Saini¹,

Chauhan²,

Kiran³

et al. 2015

WJCS

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Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.

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Section: Discussionsupporting

confidence: 91%

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Saini¹,

Chauhan²,

Kiran³

et al. 2015

WJCS

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“…[108][109][110][111][112][113][114][115][116][117][118] Parasternal Intercostal and Paravertebral Blocks Parasternal intercostal and paravertebral blocks reduce acute postoperative pain. [119][120][121][122] Despite this, there is no evidence that either has an effect on chronic poststernotomy pain. 121,123 Intrapleural Injection Intrapleural local anesthetic injections have been utilized for pain control following thoracotomy with mixed results.…”

Section: Transdermal Lidocainementioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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“…Susan B et al [7] showed parasternal block and infiltration of local Bupivacaine in the sternotomy wound and mediastinal tube sites can be a useful analgesic adjunct in the first four to six hours after cardiac surgery. Panagiotakopoulos V showed that 64% of patients didn't experience any significant pain at all, 29% experienced improved pain compared with the other cardiac surgical patients and only 7% of the patients enrolled in this study experienced the "usual" pain [6,19,[21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Parasternal Injection of Bupivacaine on Postopeartive Pain for Early Extubation in Patients Undergoing Coronary Artery Bypass Surgery

Rahman¹,

Siddiqi²,

Husain³

et al. 2016

JCCR

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Objectives: The aim of this study was to determine the efficacy of parasternal injection of Bupivacaine on postoperative pain for early extubation in patients undergoing coronary artery bypass grafting. Material and methods:Patients admitted throughout patient department for elective primary coronary artery bypass surgery into the surgical ward were enrolled for the study. A total of 35 patients were randomized into two groups, (Bupivacaine) group 1 13 (37.14%) and (Placebo) group 2 15 (42.85%). Patients were induced with standard anesthetic protocols. Bupivacaine injection 0.5% at 2mg per kg was diluted in 50 mls syringe with normal saline and 50mls of normal saline was used as Placebo. Identical syringes marked with a study number of patient were delivered to the operating theaters. Both the surgeon and the anesthetist were blinded of the content of the solution. At the end of the procedure the injection was infiltrated into the parasternal wound before placing the sternal wires. Patients were assessed in the intensive care unit by the anesthetist for early extubation. At the time of extubation pain intensity was measured with Visual analogue scale system and recorded.

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Parasternal Intercostal Block With Ropivacaine for Pain Management After Cardiac Surgery: A Double-Blind, Randomized, Controlled Trial

Cited by 78 publications

References 20 publications

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

Chronic Poststernotomy Pain

Efficacy of Parasternal Injection of Bupivacaine on Postopeartive Pain for Early Extubation in Patients Undergoing Coronary Artery Bypass Surgery

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